Chan Doan Dieu Tri BS Lam Minh Yen

8/21/2019 Chan Doan Dieu Tri BS Lam Minh Yen

1/19

LAM MINH YEN, MD2015


2/19

I. EPIDEMIOLOGYII. SYMPTOMS

III. COMPLICATIONIV. DIAGNOSISV. TREATMENTVI. PREVENTION AND INFECTION CONTROLVII. EXPERIENCES FROM KOREAVIII. REFERENCES


3/19

Coronavirus causes a range from common cold tosevere respiratory syndrome (SARS).

2012: novel coronavirus from Middle East identified in

Saudi Arabia MERS-CoV. 26 countries: 0 06 201 120 confirmed cases

death (37,1%) Middle East: Saudi Arabia (85%), Jordan, Kuwait, Oman,

Qatar, The UAE (8%), Yemen.

Europe: Austria, France, Italy, Germany, Greece, UK,Turkey. Africa: Algeria, Tunisia, Egypt. USA. Asia: the Republic of Korea, China, Malaysia, Philippines.


4/19

MERS-CoV is zoonotic virus, transmitted fromcamels to human.

The origin of virus is believed in bats andtransmitted to camels Exact role of camels in transmission of virus and

exact routes of transmission are unknown. Virus not passed easily from person to person

unless close contact and unprotected personalprotective equipment PPE to patient.

No antivirus treatment and no vaccination.


5/19

Incubation period: 2 – 14 days, usually 5 -6days.

Respiratory symptoms: no symptomsmild

Fever

Shortness of breath.

Cough. Dyspnea

Pneumonia


6/19

Others:

Diarrhea

Nausea Vomiting

Headache

Myalgia


7/19

Leukopenia, lymphopenia. Thrombocytopenia

LDH


8/19

High risk factors:

Elderly

Diabetes Chronic lung diseases: asthma, COPD

Chronic renal diseases

Cancer Weakened immune systems


9/19

Complications:

ARDS.

Acute renal failure. Multi-organ failure

Coagulopathy


10/19

Suspected case:

Fever, cough, shortness of breath, pneumonia or

ARDS. And either:

▪ Travel /living from Middlel East within 10 days (WHO 14days) before ill OR

▪ Close contact (# 2m) with probable case or confirmedcase


11/19

Probable case:

Clinical symptoms.

AND direct contact with confirmed case: HCWs,relatives or visitors


12/19

Confirmed case:

Clinical symptoms

Real time PCR (+) with nasal pharyngeal swabs,sputum, tracheal aspirate, BAL.


13/19

No antivirus treatment Based on experiences with SAR-CoV: first-line treatment if availble

Convalescent plasma Hyper –immune globulin

Human monoclonal antibodies Ribavirine + interferon alpha 2b: promising in vitro also in animal studies

but not effective in 5 patients. Supportive treatment:

Fever killer Antibiotic as nosocomial infection Gammaglobulin PIV 200 – 400 mg/kg single dose

Water and electrolyte balance. Mechanical ventilation. Hemofiltration. ECMO


14/19

Criteria for discharge:

No fever at least 5 days without pain killer.

Normal vital sign, normal blood test, improve lungX-ray.

Normal renal function.


15/19

The largest nosocomial outbreak outside the Middle East. 20/05/201 5, first case reported, travelled KSA, Qatar, UAE

and Bahrain. Ill in Korea 64 confirmed cases (HCWs,patients shared room/ward, relatives), 5 died, > 2000contacts in quarantine and isolation home or hospital, 24

osp ta s as - o pat ents osp ta w t umantransmission (07/06/2015)

One exposure in Korea Hongkong (plane)Guandong(bus), ill while traveling in China first case in China.

All viral transmission before adequate infection preventionand control procedures applied. Same situation in May2014 in KSA.

Critical to prevent: enhance infection prevention andcontrol awareness and implementary measures.


16/19

Recommendations:

Identify early patient.

Separate isolation. Minimize the number of contacts.

Standard precaution.

Droplet precautions.


17/19

Infection prevention and control measuresare critical.

Standard precaution including dropletprecaution.

HCWs: educated, trained, refreshed withskills on infection prevention and control.


18/19

http://www.who.int/mediacentre/factsheets/mers-cov/en/# http://www.who.int/csr/disease/coronavirus_infections/risk-

assessment-3june2015/en/# http://www.who.int/csr/disease/coronavirus_infections/faq/e

n : acts eet c o truy n t ng http://www.cdc.gov/coronavirus/mers/about/index.html http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178802/:

dong thuan cua Nhom NC Corona http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178802/:

Rooting Corona Vietnamese guideline for diagnosis and treatment MERS-

CoV from MOH 2014.


19/19

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Chan Doan Dieu Tri BS Lam Minh Yen